What are the typical symptoms and clinical findings of elbow bursitis?

Symptoms of Elbow Bursitis

Elbow bursitis typically presents with localized swelling over the olecranon (posterior elbow), pain with direct pressure or elbow flexion, and may be accompanied by warmth and erythema, particularly when infection is present.

Clinical Presentation

Primary Symptoms

• Swelling: The hallmark finding is a visible, palpable fluid collection over the posterior elbow at the olecranon bursa 1, 2
• Pain: Localized pain over the olecranon that worsens with direct pressure or elbow flexion 1, 3
• Tenderness: Point tenderness directly over the bursa, distinct from the medial or lateral epicondyles 4

Inflammatory Signs (Septic vs. Aseptic)

Critical distinction: Septic bursitis can present without obvious skin lesions or fever, making clinical differentiation from non-septic bursitis challenging 2. Key features include:

• Warmth and erythema: More prominent in septic cases but can occur in traumatic bursitis 1, 2
• Fever: Present in only some cases of septic bursitis; absence does not rule out infection 2
• Skin lesions: Often absent even in confirmed septic cases 2

Range of Motion

• Preserved active range of motion: Unlike intra-articular pathology, elbow bursitis typically maintains relatively normal active range of motion 4
• Pain with passive flexion: May occur due to bursal compression but differs from the pain pattern seen with intra-articular pathology 4

Radiographic Findings

Plain Radiography

• Olecranon spurs: Present in approximately 57% of traumatic olecranon bursitis cases (compared to 14% in controls) 5
• Calcium deposits: Amorphous calcifications may be visible within the bursa 5
• Soft tissue swelling: Visible on lateral radiographs 5

Ultrasound Findings

• Bursal effusion: Fluid collection detectable on ultrasound examination 6
• Bursal wall thickening: May indicate chronic or inflammatory changes 6

Red Flags Requiring Bursal Aspiration

Maintain high clinical suspicion for septic bursitis even without classic signs 2:

• Progressive swelling despite conservative management 1
• Significant warmth or erythema 1
• History of direct trauma with skin breach 3
• Immunocompromised status 1

Synovial Fluid Analysis (When Septic Bursitis Suspected)

• White blood cell count >3000 cells/mm³ suggests infection 1
• Presence of bacteria on Gram stain 1
• Culture: Most commonly grows Staphylococcus aureus 1

Common Pitfalls

• Assuming absence of fever or skin lesion rules out infection: Septic bursitis frequently presents without these findings 2
• Confusing with cellulitis: The localized, fluctuant swelling of bursitis differs from the diffuse erythema of cellulitis 3
• Failing to differentiate from intra-articular pathology: Bursitis maintains better active range of motion and has point tenderness over the bursa rather than joint line tenderness 4